Metabolic-Associated Steatohepatitis (MASH) Treatment: Medication, Lifestyle Changes, and More
Published on October 2, 2025
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Metabolic dysfunction-associated steatohepatitis, or MASH, is a harmful buildup of fat and inflammation in the liver that can cause liver scarring and cirrhosis. Once known as nonalcoholic steatohepatitis, MASH is an advanced form of liver disease that can be controlled with medications, lifestyle changes, and possibly surgery to reduce your risk of complications.
The treatment best choice for you depends on factors such as how severe your MASH is (based on the amount of fibrosis or scarring in the liver) and the status of your overall health.
Medications to Treat MASH
There are only two drugs that are specifically approved to treat MASH. Both can be effective, so you should talk with your doctor to decide which medication is right for you, says Omar Khokhar, MD, a gastroenterologist who specializes in liver diseases at OSF Healthcare in Bloomington, Illinois.
Resmetirom (Rezdiffra)
Resmetirom is an oral medication that treats MASH that includes fibrosis, which is scarring of the liver. Approved in 2024, it’s the first treatment designed to directly address existing liver damage.
Resmetirom binds to and activates a protein receptor in the liver that regulates fat metabolism and inflammation. That helps reduce the amount of fat in the liver and decrease inflammation and scarring.
“It’s been shown to improve liver scarring levels in patients with moderate scarring,” Dr. Khokhar says. However, the drug is not for people with decompensated cirrhosis, or advanced liver scarring.
Common side effects of resmetirom include diarrhea and nausea. Serious adverse effects, though rare, can include drug-induced liver toxicity and gallbladder-related side effects.
Semaglutide (Wegovy)
Semaglutide, the injectable drug that’s often prescribed to manage diabetes and obesity, is now approved to treat MASH in adults with moderate-to-advanced liver scarring. Since those conditions are more common in people with MASH, semaglutide can be a good choice for managing blood sugar and weight while improving a person’s liver health, says Khokhar.
Semaglutide is a GLP-1 agonist that mimics the actions of GLP-1, a hormone that occurs naturally in the body to improve blood sugar control and aid weight loss by slowing digestion and keeping people feeling full. These effects can help reduce inflammation in the liver and improve scarring.
Side effects of semaglutide can include:
- Nausea, diarrhea, and vomiting
- Constipation
- Abdominal pain
- Headache
- Fatigue
- Indigestion
- Dizziness
- Gas and acid reflux
- Low blood sugar in people with type 2 diabetes
Supportive Medications
Your doctor may recommend additional treatments when you have MASH, especially if you also have other conditions like high cholesterol, high blood pressure, or diabetes.
“While most of these drugs do not target liver-related outcomes directly, they are important modifiers of cardiovascular mortality, which is the most common cause of death in individuals with MASH,” says Anahita Rabiee, MD, an assistant professor of digestive diseases at Yale School of Medicine in New Haven, Connecticut.
Statins
Statins are cholesterol-lowering medications that work by blocking an enzyme that the liver needs to produce cholesterol. They can help decrease your LDL (“bad”) cholesterol by as much as 50 percent, which can significantly reduce your risk of a heart attack or stroke.
Medications in this class include:
- Atorvastatin (Caduet, Lipitor)
- Fluvastatin
- Lovastatin (Mevacor, Altoprev)
- Pitavastatin (Livalo, Zypitamag)
- Pravastatin
- Rosuvastatin (Crestor, Ezallor Sprinkle)
- Simvastatin (FloLipid, Vytorin, Zocor)
Statins can cause side effects including:
- Headache
- Nausea
- Dizziness
- Gas
- Diarrhea
- Constipation
- Muscle pain
- Memory loss or confusion
Rarely, they can also cause kidney damage, muscle tissue breakdown, or high blood sugar.
Statins can also potentially lead to liver damage, however, the medications are generally considered safe for people with MASH.
Antihypertensive Drugs
It’s important to keep your blood pressure within a healthy range to lower your heart attack and stroke risk when you have MASH. If your levels are high (typically above 130/80 mmHg), your doctor may recommend an antihypertensive medication to help lower your blood pressure.
Medications in this class include:
- Angiotensin-converting enzyme (ACE) inhibitors, such as benazepril (Lotensin), captopril (Capoten), and enalapril (Epaned and Vasotec)
- Angiotensin II receptor blockers (ARBs), such as azilsartan medoxomil (Edarbi), candesartan (Atacand), eprosartan mesylate (Teveten), and losartan (Cozaar)
- Calcium channel blockers, such as amlodipine, clevidipine, felodipine, diltiazem, and verapamil
- Diuretics (water or fluid pills), such as thiazide diuretics (hydrochlorothiazide or chlorthalidone), loop diuretics (furosemide or bumetanide), or potassium-sparing diuretics (triamterene or amiloride)
Common side effects of antihypertensive drugs can include:
- Cough
- Diarrhea
- Constipation
- Dizziness
- Trouble getting or maintaining an erection
- Feeling nervous
- Weakness and fatigue
- Nausea or vomiting
- Skin rash
- Unintended weight loss or weight gain
Diabetes Drugs
MASH and insulin resistance are closely related. If you have type 2 diabetes, your high blood sugar could worsen the health of your liver, which in turn could make your blood sugar even harder to control.
If your doctor hasn’t prescribed semaglutide, which is approved to treat both MASH and high blood sugar, they could recommend another type of injectable or oral treatment to help keep your blood sugar levels within a healthy range.
Medications may include:
- Metformin (Glucophage)
- Dipeptidyl peptidase 4 (DPP-4) inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), or linagliptin (Jentadueto)
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors, such as canagliflozin (Invokana), dapagliflozin (Farxiga), or empagliflozin (Jardiance).
- Sulfonylureas, such as glipizide (Glucotrol, Glucotrol XL), glimepiride (Amaryl), or glyburide (Micronase, Glynase)
- Thiazolidinediones (TZDs), such as pioglitazone (Actos) and rosiglitazone (Avandia)
Different diabetes drugs can cause different side effects. Depending on the medication your doctor prescribes, you may experience side effects such as:
- Diarrhea
- Nausea
- Vomiting
- Genital yeast infections
- Low blood sugar
- Weight gain
- Swelling in the legs or feet
Liver Transplantation
When untreated, MASH can cause cirrhosis or severe liver scarring, which can eventually lead to liver failure. If a person’s MASH has reached this point, they may be a candidate for a liver transplant. While it’s relatively rare for MASH to progress to this point, it is now a top cause of liver transplants in the United States, second only to alcohol-associated liver disease.
During a liver transplant, a person’s failing liver is removed and replaced with a whole or part of a healthy liver from a donor. If a person receives part of a healthy liver, the liver can regenerate and grow to a normal size within a few months.
Liver transplantation is a major surgery, so it’s crucial to weigh the risks and benefits with your care team. Possible complications of a liver transplant can include infections, blood clots, the body rejecting the new liver, or liver cancer.
Lifestyle Changes
Healthy habits are a cornerstone of managing MASH and preventing further liver damage. Lifestyle changes alone may be enough to reverse the condition in some patients, particularly when it’s diagnosed early.
Weight Loss
Losing 5 percent of your body weight can reduce the amount of fat in your liver, and losing 10 percent or more may be enough to help heal existing scarring and reverse your MASH completely. For a 150-pound person, that’s a loss of between 7.5 and 15 pounds.
Experts recommend aiming to lose one to two pounds per week. Slow, steady weight loss is better for your liver than crash diets, and it makes it easier to maintain your results over the long term. If you’re struggling to lose weight through diet and exercise alone, weight loss surgery or medications can help.
Healthy Diet
Healthy eating choices can help you lose weight while improving things like high blood sugar, high cholesterol, and high blood pressure. Stick with nutrient-dense foods like fruits, vegetables, whole grains, beans, nuts, olive oil, and low-fat dairy. The diet most commonly recommended is the Mediterranean diet, which has also benefits for the heart in addition to liver health. Limit sugary foods, salty foods, and foods high in saturated fat like red meat and full-fat dairy. Pay attention to your portion sizes too: In order to lose weight, you need to burn more calories than you consume.
Exercise
Regular physical activity is another key component of weight loss and liver health. Try to get at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous aerobic exercise each week, in addition to doing resistance exercises twice a week. If you’re just starting out with exercise, your doctor can help you come up with a plan that works for you as your fitness improves.
Alcohol Use
Alcohol can worsen liver inflammation, even if you only drink a moderate amount. So it’s best to simply steer clear. “There is no safe drinking limit for people with MASH,” Dr. Rabiee says.
Questions to Ask Your Doctor
- How severe is my MASH, and will it require specialty care?
- How can MASH affect my long-term health, including risks of cirrhosis or liver cancer?
- How does MASH impact my risk of other conditions, such as diabetes or heart disease?
- How often should I have liver imaging or biopsies to check for disease progression?
- What lifestyle modifications should I be making to keep my MASH from getting worse?
- Are there any medications or supplements I should avoid because they could worsen my liver condition?
- What symptoms or changes in my health should prompt me to seek immediate medical attention?
- How can I safely lose weight without harming my liver, given my condition?
- Can I drink alcohol if I have MASH?
Complementary and Integrative Approaches
In addition to healthy lifestyle changes and medications, there are a few complementary approaches that might further support the health of your liver. Always talk with your doctor before trying a new complementary or integrative therapy.
Coffee
Coffee contains compounds that may help protect the liver from damage and reduce the risk of scarring. You’ll need to drink at least two cups per day to reap the benefits; just limit the caloric and sugary add-ins. Whole milk or cream, sugar, or syrups can make it harder to manage your weight.
Vitamin E
Vitamin E is an antioxidant, which some research suggests could play a role in reducing inflammation-induced liver damage in MASH patients without type 2 diabetes or cirrhosis. Vitamin E isn’t powerful enough to treat MASH on its own, but it might help support your prescribed treatment plan by slowing the progression of MASH.
Talk to your doctor before taking a vitamin E pill. Supplementing can increase the risk of prostate cancer in men and bleeding in the brain, so it’s important to weigh the individual risks and benefits of vitamin E for you.
The Takeaway
- Metabolic dysfunction-associated steatohepatitis is a serious liver condition that can be managed in some patients with a combination of medications and lifestyle changes, such as eating a healthier diet, getting more exercise, and avoiding alcohol.
- People with MASH may need to take prescription drugs to treat the condition, as well as medications to target other commonly associated health conditions, such as high cholesterol, high blood pressure, or diabetes.
- In addition to medication and healthy lifestyle habits, complementary approaches like drinking coffee and supplementing with vitamin E may help protect the liver and slow the progression of MASH.
Resources We Trust
- Cleveland Clinic: Metabolic Dysfunction-Associated Steatohepatitis (MASH)
- Mayo Clinic: Cirrhosis
- American Liver Foundation: 13 Ways to a Healthy Liver
- American College of Gastroenterology: Medications and the Liver
- British Liver Trust: Diet and Liver Disease
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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- Rezdiffra Works Directly in the Liver by Stimulating THR-β to Improve Critical Hepatic Processes and Reduce Fibrosis. Rezdiffra. 2025.
- FDA Approves First Treatment for Patients With Liver Scarring Due to Fatty Liver Disease. U.S. Food and Drug Administration. March 14, 2024.
- FDA Approves Treatment for Serious Liver Disease Known as ‘MASH’. U.S. Food and Drug Administration. August 15, 2025.
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- Statins. Cleveland Clinic. March 12, 2024.
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- Younossi Z et al. The Changing Epidemiology of Adult Liver Transplantation in the United States in 2013–2022: The Dominance of Metabolic Dysfunction–Associated Steatotic Liver Disease and Alcohol-Associated Liver Disease. Hepatology Communications. December 22, 2023.
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Yuying Luo, MD
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Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.
Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.
She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.
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Marygrace Taylor is a health writer and editor based in Philadelphia. Her work has appeared in publications including Parade, Glamour, Women's Health, Prevention, Redbook, Men's Health, and O, The Oprah Magazine. She's also the coauthor of Eat Clean, Stay Lean: The Diet and Prevention Mediterranean Table.